Objective: Case report

Background: Tetany is a sustained muscle contraction that mainly affects distal segments of extremities and facial and laryngeal muscles and is accompanied by sensory symptoms.

Method: Clinical case

Results: A 12 weeks’ pregnant woman with no medical records is committed in the general surgery ward for a 3 week’s history of nausea, vomiting and pain in the right hypochondrium with an acute alithiasic pancreatitis. On the last days at the ward she developed and acute and extremely painful bilateral hand posture associated with peri-oral paraesthesia. She was medicated with ondansetron and paracetamol.

The neurologic exam revealed a bilateral symmetric painful hand contracture similar to the obstetrician hand. Chvostek and Trosseau sign were present. No sensory deficits.

Blood gas analysis did not show any acid-base disturbance. Blood work revealed normocytic anaemia of 9g/L, mild leucocytosis 13 000 and a mild cholestatic liver pattern. Electrolyte panel showed normal ionized calcium and slight hypomagnesemia 1.3mg/dL. Kidney function was normal.
Intravenous magnesium sulfate reposition solved the clinical picture in a matter of hours.

Conclusion: This is an unusual case as these symptoms have not been described with such borderline serum electrolyte levels. Clostridium tetani, alkalosis and calcium deficiency are the main causes of tetany, but other causes should be pursued as this is usually a multifactorial condition with hypomagnesemia and some medications that may contribute or be the main cause of the clinical picture.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/obstetrician-hands-in-a-pregnant-woman/